Recurrent acute coronary syndrome in a patient with right coronary artery ectasia: a case report
| Autor: | Raymond Pranata, Vito Damay, Wendy Wiharja |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Acute coronary syndrome medicine.medical_treatment lcsh:Medicine Case Report Coronary Artery Disease 030204 cardiovascular system & hematology Anterior Descending Coronary Artery Coronary Angiography Medication Adherence 03 medical and health sciences 0302 clinical medicine Patient Education as Topic Recurrence medicine.artery Ectasia Internal medicine medicine Humans cardiovascular diseases business.industry Unstable angina lcsh:R Coronary artery ectasia Anticoagulant Anticoagulants Stent General Medicine Middle Aged medicine.disease Coronary arteries Treatment Outcome medicine.anatomical_structure 030220 oncology & carcinogenesis Right coronary artery Cardiology Drug Therapy Combination Microvascular Warfarin business Platelet Aggregation Inhibitors |
| Zdroj: | Journal of Medical Case Reports Journal of Medical Case Reports, Vol 13, Iss 1, Pp 1-5 (2019) |
| ISSN: | 1752-1947 |
| DOI: | 10.1186/s13256-019-1979-x |
| Popis: | Background Coronary artery ectasia is characterized by an abnormal dilatation of the coronary arteries. Coronary artery ectasia is observed in 3–8% of patients undergoing coronary angiography and sometimes leads to acute coronary syndrome regardless of the presence or absence of coronary stenosis or atrial fibrillation. Case presentation A 61-year-old Indonesian man presented with typical angina that began 1 week before admission and had worsened 3 hours prior to admission. Accompanying symptoms included dyspnea, nausea, and sweating. He was hemodynamically stable and had a history of tobacco smoking and dyslipidemia. An electrocardiogram showed ST-segment depression and T inversion. Laboratory results showed an international normalized ratio of 1.28. Dual antiplatelet therapy was administered along with fondaparinux, and symptoms were alleviated. Coronary angiography showed an ectatic and turbulent mid-distal right coronary artery and slow flow at the first presentation. There was a patent stent in the proximal-mid left anterior descending coronary artery. This patient had previously presented with recurrent acute coronary syndrome and received two coronary stents for the stenotic vessels. Discussion He had right coronary artery ectasia and experienced recurrent acute coronary syndrome. He received dual antiplatelet therapy along with warfarin after stenting of his left anterior descending coronary artery. However, he presented with unstable angina pectoris 7 months before the latest admission and at the latest admission despite a patent stent and no other significant obstructive lesion. The unstable angina pectoris might have been caused by slow flow, microvascular angina caused by small thrombi and/or vasospasm, or epicardial thrombosis at the ectatic coronary artery that dissolved after anticoagulation therapy prior to coronary angiography. Anticoagulant therapy may have a greater benefit than antiplatelet therapy in this patient due to the turbulence and stasis of blood in the ectatic vessel, although coexisting coronary conditions mandated antiplatelet therapy. His international normalized ratio was suboptimal and needed to be improved. Conclusion Coronary ectasia may play a role in recurrent acute coronary syndrome, and administration of an anticoagulant to prevent acute coronary syndrome in this patient was in accordance with the varying hemodynamic property of coronary artery ectasia. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink